Impact of radiation and chemotherapy on risk of dental abnormalities

A report from the Childhood Cancer Survivor Study

Authors

  • Sue C. Kaste DO,

    Corresponding author
    1. Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    3. Department of Radiology, University of Tennessee School of Health Sciences, Memphis, Tennessee
    • Department of Radiological Sciences, St. Jude Children's Research Hospital, MS 220, 262 Danny Thomas Place, Memphis, TN 38105===

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    • Fax: (901) 595-3981

  • Pamela Goodman MS,

    1. Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
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  • Wendy Leisenring ScD,

    1. Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
    2. Clinical Statistics Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
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  • Marilyn Stovall PhD,

    1. Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Robert J. Hayashi MD,

    1. Department of Pediatrics, Washington University, St. Louis, Missouri
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  • Mark Yeazel MD,

    1. Department of Family Medicine and Community Heath, University of Minnesota, Minneapolis, Minnesota
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  • Soraya Beiraghi DDS,

    1. Department of Developmental and Surgical Science, University of Minnesota, Minneapolis, Minnesota
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  • Melissa M. Hudson MD,

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Charles A. Sklar MD,

    1. Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
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  • Leslie L. Robison PhD,

    1. Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • K. Scott Baker MD, MS

    1. Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Abstract

BACKGROUND:

The current study was performed to describe frequencies and risk factors of altered oral health and odontogenesis in childhood cancer survivors.

METHODS:

In total, 9308 survivors who were diagnosed between 1970 and 1986 and 2951 siblings from the Childhood Cancer Survivor Study completed a survey that contained oral-dental health information. The authors analyzed treatment impact, socioeconomic data, and patient demographics on dental outcomes using univariate and multivariate logistic regression models to estimate odds ratios (ORs).

RESULTS:

In multivariate analysis, survivors were more likely to report microdontia (OR, 3.0; 95% confidence interval [95% CI], 2.4-3.8), hypodontia (OR, 1.7; 95% CI, 1.4-2.0), root abnormalities (OR, 3.0; 95% CI, 2.2-4.0), abnormal enamel (OR, 2.4; 95% CI, 2.0-2.9), teeth loss ≥6 (OR, 2.6; 95% CI, 1.9-3.6), severe gingivitis (OR, 1.2; 95% CI, 1.0-1.5), and xerostomia (OR, 9.7; 95% CI, 4.8-19.7). Controlling for chemotherapy and socioeconomic factors, radiation exposure of ≥20 Gray to dentition was associated significantly with an increased risk of ≥1 dental abnormality. Dose-dependent alkylating agent therapy significantly increased the risk of ≥1 anatomic/developmental dental abnormalities in survivors who were diagnosed at age <5 years (OR, 1.7, 2.7, and 3.3 for alkylating agent scores of 1, 2, and 3, respectively).

CONCLUSIONS:

Radiation and chemotherapy were independent risk factors for adverse oral-dental sequelae among childhood cancer survivors. The authors concluded that patients who received receiving alkylating agents at age <5 years should be closely monitored. Cancer 2009. © 2009 American Cancer Society.

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